Hayden Panettiere died from an accidental overdose that included fentanyl, coroner’s office says

By Holly Yan, Deidre McPhillips, CNN

(CNN) — Actress Hayden Panettiere, who publicly shared her struggles with early fame and addiction, died from a toxic mix of fentanyl and other substances, authorities in South Carolina said Tuesday.

Her death has been ruled an accident, the Greenville County Coroner’s Office said. But thousands of miles away, investigators have been looking into whether the 36-year-old obtained illicit and possibly counterfeit drugs from a dealer in Southern California.

Panettiere, who starred in the TV shows “Heroes” and “Nashville,” was pronounced dead at a Greenville apartment on August 16. Medics responding to a 911 call found the 36-year-old in cardiac arrest and were unable to resuscitate her.

The coroner’s office ruled the cause of death as the “toxic effects of fentanyl, 4-ANPP, Alprazolam, Methocarbamol, and Quetiapine.”

‘A deathly mixture’

Fentanyl alone can be fatal, said Dr. Kendall Von Crowns, a forensic pathologist who was not involved in Panettiere’s case. But fentanyl combined with 4-ANPP, alprazolam, methocarbamol and quetiapine “is a deathly mixture that we see often in cases.”

“Alprazolam (Xanax) is commonly abused and methocarbamol (muscle relaxer) in combination without the fentanyl could be fatal at high enough levels,” said Crowns, the chief medical examiner in Tarrant County, Texas.

“All these drugs result in respiratory depression, which means it makes your brain not realize that it’s not getting enough oxygen. You go into a coma and eventually die from anoxic brain damage.”

The presence of 4-ANPP is notable because it’s “a marker for a fentanyl that was not created in a pharmaceutical lab, meaning it’s a clandestine manufactured fentanyl. It can also be seen as a metabolite of fentanyl as well,” Crowns told CNN.

“So this could mean that the fentanyl taken was manufactured illicitly,” he said. But illicitly manufactured fentanyl can contain varying amounts of fentanyl.

“Again, the fentanyl itself could be fatal, but we don’t know the levels based on what we’re looking at.”

Fentanyl and other synthetic opioids are involved in more than half of all overdose deaths in the United States, according to data from the US Centers for Disease Control and Prevention.

While overdose deaths have dropped significantly over the past few years, the most recent provisional data suggest fentanyl and other synthetic opioids were involved in more than 35,000 US deaths in the past year.

Despite concluding the actor’s death was accidental, authorities continue investigating whether anyone might be criminally responsible for providing her with a lethal substance.

Drug Enforcement Administration agents and Los Angeles-area authorities have questioned several people about the circumstances surrounding the California resident’s death, a source familiar with the case said last week.

Investigators were looking into whether Panettiere may have taken a counterfeit narcotic and whether it may have interacted with any other substances in her body at the time of her death, the source added.

“The investigation remains ongoing and the circumstances surrounding the case are complex,” Panettiere’s representative, Kasey Kitchen, said in a statement to CNN shortly after the coroner’s report. “We must all continue to remain patient and allow the investigative process to unfold.”

A lifetime in the spotlight

The actress had spoken publicly about her battles with mental health and substance abuse. Postpartum depression and addiction plagued her young adult years and temporarily halted the career that began when she was less than a year old.

But this year, Panettiere addressed her struggles in a memoir and spoke publicly about losing her brother. And her career was making a comeback, with her latest film released in January.

So when the 36-year-old was pronounced dead in the South Carolina apartment building, shock and grief stretched from Hollywood to Ukraine. Panettiere’s ex-partner, former Olympic and world boxing champion Wladimir Klitschko, paid tribute to Panettiere and vowed to make sure their daughter Kaya would always remember her mother.

Panettiere “had been temporarily staying” at the apartment in Greenville, the coroner’s office said in August. Authorities did not say whose apartment it was.

Her boyfriend, Brian Hickerson, and his brother Zach called 911 the afternoon of August 16 to say Panettiere was unresponsive, according to a Greenville police incident report. The brothers were questioned separately at the scene, and Brian Hickerson gave an officer a bag of Panettiere’s medications, the report said.

The Hickersons have roots in Greenville, where some of their family members live. According to the police report, Brian Hickerson lived in California, and Zach Hickerson lived in Georgia.

Panettiere’s death – along with revelations from her recently released memoir – cast new light on the challenges of growing up in the public spotlight.

Her tragic fate has inspired other former child stars to speak out about the pressure and struggles that often accompany fame at an early age.

This story has been updated with additional information.

CNN’s Nadia Kounang, Elizabeth Wolfe, Josh Campbell and Elizabeth Wagmeister contributed to this report.

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